Joshua Gunter, The Plain DealerDiagnosed with esophageal cancer in 2008, Bruno Kowalewski, right, had surgery to remove his esophagus. Younger brother John is being treated for Barrett's esophagus, a precancerous condition.

This year, the National Cancer Institute launched the Barrett's Esophagus Translational Research Network as a way to provide resources for researchers interested in studying esophageal cancer -- a topic that, until the past decade, hadn't received much attention, even as the number of cases is on the rise.

Three collaborative research groups successfully answered the institute's nationwide call for proposals. One of those winning groups is being led by Dr. Amitabh Chak, professor of medicine at Case Western Reserve University School of Medicine and a gastroenterologist at University Hospitals Case Medical Center.

Chak will oversee the Barrett's Esophagus Translational Research Network at CWRU School of Medicine and the Case Comprehensive Cancer Center. The network was established with a five-year, $5.4 million institute grant.

Increasing numbers

Esophageal cancer forms in the cells that line the esophagus, the tube from the pharynx that contracts to help move food and liquid from the throat to the stomach.

Nearly 17,000 new cases will be diagnosed in the United States in 2011, and nearly 15,000 people will die of the disease in 2011, according to estimates from the National Cancer Institute.

In the United States, the rate of adenocarcinoma esophageal cancer has increased during the last 20 years.

Building on Chak's ongoing work, which has contributed to discovering better ways of screening and managing Barrett's -- a precancerous condition that about 10 percent of people who have acid reflux develop -- the network will study the role of genetics and the environment on disease progression.

"It's exciting for us," Chak said. "This is a new format where we can collaborate between institutions. It's an illustration of how new research is being done. It's a huge team that works together, not just one individual."

Chak will lead the local network, along with fellow CWRU professors Dr. Sanford Markowitz and Dr. Nathan Berger, both oncologists at UH Seidman Cancer Center; and Robert Elston, CWRU's department chairman of epidemiology and biostatistics.

The team also includes researchers from the Mayo Clinic, University of North Carolina at Chapel Hill, University of Pennsylvania, University of Washington and Fred Hutchinson Cancer Research Center, and Washington University.

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Many of those centers have a history of collaboration through the Familial Barrett's Esophagus Consortium, which Chak developed in 1998.

"Because we had that infrastructure in place, we were able to show that we already had collaborations going," he said.

To date, the consortium has followed individuals from more than 300 families in which one or more members have been diagnosed with Barrett's esophagus, to see how much genetics plays a role.

With Barrett's, the lining of the esophagus is damaged, and the esophageal sphincter, which helps keep food down, is loosened. About 1 in 200 of those cases develops into adenocarcinoma esophageal cancer, one of the deadliest cancers to treat.

The institute grant gives local researchers the resources to conduct new studies to try to identify the genes involved in disease progression, Chak said. "If we can identify the gene, we can look at [others] who might be at risk for developing this."

The Kowalewski family has been on Chak's radar ever since he began treating Bruno Kowalewski of Seven Hills several years ago.

Kowalewski, 78, says he had suffered from acid reflux for as long as he could remember. It was so bad sometimes that the only way he could sleep was sitting in his recliner with his head up.

An initial endoscopy to see if there was any evidence of dysplasia, or cell abnormality, led to a diagnosis of Barrett's esophagus. That led to a second opinion at UH and the first meeting with Chak.

Chak had Kowalewski come in for follow-up endoscopy every six months, then every three months.

In late January 2008, while attending an out-of-state conference, Chak had his office send him the results of Kowalewski's latest endoscopy. That night, he called Kowalewski to tell him that he had esophageal cancer.

Scheduled to leave on a cruise the next day, Kowalewski and his wife canceled their trip.

"I really feel like Dr. Chak saved my life," said Kowalewski, who had surgery to remove his esophagus three weeks later. "He had been watching me so closely."

Soon, Chak will be keeping an eye on Kowalewski's three adult children.

For nearly two years, since Bruno was diagnosed with Barrett's, his brother, John Kowalewski of North Royalton, also has been under Chak's care. The younger Kowalewski, 71, is scheduled to see Chak in February, for the first time in a year.

"I'm hoping that [the endoscopy shows] there is no difference, with the medication I'm taking," he said, referring to the proton pump inhibitor prescribed to treat Barrett's. "I hope I can control it. I don't want to go through what my brother went through."

No longer is surgical removal of the esophagus the only way to treat patients with esophageal cancer.

"We now have ways of treating individuals with endoscopy," Chak said. "We try to cure the high-grade dysplasia."

Those newer treatments, not yet available when Bruno Kowalewski had his surgery, are what Chak is using with the younger brother.

"We have better methods of identifying [dysplasia] and are getting better methods to develop treatments that seem to be effective," Chak said.

Ideally, someone will be able to develop a simple genetic test within the next five years, Chak said. The test would be able to tell which people need to treat their Barrett's esophagus with repeated endoscopy and which don't.

Research published in the New England Journal of Medicine in Octobersuggested that the risk of a person with Barrett's esophagus developing esophageal cancer is much lower than previously thought.

"I think we overestimated that risk," said Chak, who is mindful of alarming people unnecessarily, especially those who are heartburn sufferers. In fact, nearly 40 percent of people who develop esophageal cancer have no preceding symptoms of heartburn, he said.

"[The New England Journal of Medicine research] points out that we need better methods of finding who in that Barrett's esophagus group is at risk and needs to be followed more closely."

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